What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through “Medicaid Waivers,” which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
This Iowa Medicaid Health & Disability (HD) Waiver offers supports for physically disabled persons younger than age 65, and who qualify for Medicaid. The focus of the HD Waiver centers on consumer-directed services to help physically disabled Iowans receive care and other support services in their own home to prevent unnecessary nursing home placement.
Once approved for the waiver, participants can exercise a great deal of control over their choice of services, as well as their choice of provider, as long as the service provider is approved under the HD Waiver program. Hence the phrase consumer-directed. This self-directed option under this waiver is called the Consumer Choices Option. It allows for consumer directed attendant care for those not only residing in their own homes, but also for those in assisted living facilities or adult foster care homes. Attendant care encompasses both skilled and unskilled services, including monitoring medications, checking vital signs, and providing assistance with hygiene, mobility, and toileting. Please note, relevant to adults, spouses and legal guardians cannot be hired to provide care.
This Iowa Home and Community-based Services (HCBS) Medicaid waiver is administered by the Iowa Department of Human Services. Upon reaching the age of 65, HD Waiver participants are generally able to receive services under the Elderly Waiver, another Iowa HCBS Medicaid waiver.
The Iowa Department of Human Services (DHS) Iowa Medicaid Enterprise (IME) is the single state agency responsible for the oversight of Medicaid.
This program serves Iowans under the age of 65 who are physically disabled. However, this does not include people who are solely suffering with mental disabilities, such as dementia or Alzheimer’s. While those individuals are not excluded, the symptoms of their conditions must manifest themselves physically.
In addition to the disability requirement, Iowa Medicaid has financial requirements with regards to the applicant’s income and assets.
2022 Income Limits – A single applicant’s monthly income cannot exceed 300% of the federal benefit rate. This means an applicant is limited to less than $2,523 per month or $30,276 per year in personal income. Should the applicant be married, and their spouse is not seeking Medicaid eligibility, some income can be re-distributed to the non-applicant spouse as a “needs allowance.” This is also called a spousal allowance and allows the applicant spouse to transfer as much as $3,435 per month to the non-applicant spouse.
2022 Asset Limits – Asset limits are more complex, as there are countable assets and exempt (non-countable) assets. Included in the latter is one’s home as long as the owner lives in the home and the value is not greater than $636,000. Also exempt are personal items, furniture, a vehicle and certain funeral trusts. Countable assets are essentially everything else, such as savings, stocks, additional vehicles, and property. The value of the applicant’s countable assets cannot exceed $2,000. If married, a non-applicant spouse can claim ownership of joint assets up to a value of $137,400. (All assets of a married couple are considered jointly owned. Learn more here.) This is called a community spouse resource allowance (CSRA). It is in place to prevent the non-applicant spouse from having too little from which to live.
Should an individual have income and / or assets over these limit(s) they might still become eligible through creating a Qualified Income Trust or by working with a Medicaid planning professional. Learn more here.
Benefits and Services
The HD Waiver covers a broad spectrum of services, placing a high priority on consumer choice and direction. This allows participants to exercise control over aspects such as choosing their provider of care or counseling, and which types of service they need.
Services may include:
- Adult day care
- At-home nursing
- Mental health counseling / outreach
- Assistance from a home health aide
- Interim medical monitoring and treatment
- Personal emergency response services (PERS)
- Home/vehicle modifications
- Home-delivered meals
- Nutritional counseling
- Respite services
This program is “cost-neutral.” This means that once an applicant is determined to be eligible, the total cost of services administered cannot exceed the costs of placing the recipient in a nursing home.
How to Apply / Learn More
The HD Waiver is available to residents of all counties in Iowa, although a waiting list likely exists, even for qualified applicants. To apply, Iowans should contact their local county office of the Iowa Department of Human Services. To view a full description of the HD Waiver, click here.
In 2020, a waiting list is in effect for many of Iowa’s waiver programs, including the HD Waiver.